Background: Due to the rapid development of new diagnostic and therapeutic endoscopic techniques, there has been a gap between their development and implementation in daily practice, as well as in their uptake in guideline recommendations1. We investigated the effectiveness of spectral focused imaging (SFI), a new optical chromoendoscopy system (SonoScape, Shenzhen, China)2, in diagnosing subtle mucosal changes in patients with inactive ulcerative colitis.

Materials and Methods: A group of 12 patients with quiescent ulcerative colitis were randomly assigned at a 1:1 ratio to undergo colonoscopy with high-definition white light (group A) or SFI (group B). The mucosal pattern, location of the mucosal changes (measured in centimeters from the anal verge), morphology, size and duration of the endoscopic procedure were recorded, while the disease activity was established following the Mayo endoscopic score for ulcerative colitis. Subsequent to the endoscopic characterization, targeted biopsies (or random biopsies in a case of normal colonic mucosa) were obtained from every segment for histopathological follow-up analysis.

Results: The median endoscopic activity index, based on the Mayo ulcerative colitis endoscopic score, was 1 for both groups of patients. Taking into account the duration of the examination, the median value was 17.3 minutes in group A and 18.5 minutes in group B Upon examining the concordance between the endoscopic prediction of disease activity and the histological findings, we obtained a 55% degree of conformity in group A, compared to 90% in group B. Conclusions: This pilot study showed that image-enhanced endoscopy using SFI might increase the rate of detection and demarcation for subtle inflammatory changes in the mucosa, correlating with potential histologic activity. Furthermore, this diagnostic tool could provide a more accurate and earlier identification of areas of minimal inflammation than conventional techniques.

Primary vaginal sarcoma is an extremely rare malignant condition within the field of gynecological pathologies. We present the case of a 53-year-old patient with no history of gynecological issues or associated comorbidities who presented to our clinic with recurrent vaginal bleeding during menopause. We want to emphasize the importance of diagnostic management, going through all the necessary steps from local gynecological examination to vaginal biopsy, optimizing results with advanced imaging techniques. Once the histopathological diagnosis of vaginal leiomyosarcoma was established, the therapeutic approach was discussed within a multidisciplinary committee consisting of a gynecologist, surgeon, and oncologist. As a result, the patient underwent tailored surgical intervention relatively quickly after presentation, followed by referral to the oncology department, where she is currently undergoing her third course of adjuvant chemotherapy. Our current objective is the long-term follow-up of the patient and the acquisition of data regarding her survival and quality of life. These facts may contribute in the future to the implementation of standardized therapeutic guidelines for such a rare condition. Keywords: vaginal sarcoma, malignant condition, vaginal leiomyosarcoma, surgical intervention, chemotherapy.

Metaplastic breast cancer (MBC) is a rare, aggressive form of breast cancer first described by pathologists in 2000. It is usually discovered in advanced stages and has a low survival rate. It is divided into various subtypes: lowgrade adenosquamous, fibromatosis-like metaplastic, squamous cell, spindle cell, metaplastic with mesenchymal differentiation (including chondroid, osseous, or other types), mixed metaplastic, and myoepithelial carcinomas. Surgery is the treatment of choice, followed by adjuvant chemotherapy and/or radiotherapy. We present the case of a 44-year-old woman with metaplastic breast cancer, reviewing the characteristics of this condition, the particularities of the case, and the treatment chosen in this particular situation.

Malignant Mixed Müllerian Tumors (MMMT) also referred to as carcinosarcomas are very rare and extremely aggressive tumors of the uterine corpus accounting for less than 1% of all gynecologic malignancies, 2-5% of all uterine malignancies and more than 15% of all uterine cancer associated deaths [1]. They occur almost exclusively in post-menopausal women, but have been reported in premenopausal women as well, including young girls [2]. Carcinosarcomas have poor prognostic outcome, regardless of stage at diagnosis. The five-year survival rate ranges between 5% and 40% for patients with tumors of all stages [2-5] and does not improve significantly even with the introduction of increasingly aggressive adjuvant therapies.

Splenic hemangioma is a vascular malformation which is one of the most common benign neoplasms of the spleen. They may represent small, incidental lesions that can produce significant splenomegaly and predispose to splenic rupture. These tumors are rare and resemble their counterparts in other organs. The vascular spaces are usually irregular and cavernous, containing abundant red blood cells.
Differential diagnoses include benign or malignant neoplasms, metastases, lymphoma, splenic abscess or cystic lesions. The incidence of autopsy examination of their diagnosis ranges from 0.03 to 14% [1], and most often is encountered in adults between the ages of 30 and 50 [2]. Most are small lesions, usually clinically silent, diagnosed accidentally. Sometimes, however, they may be symptomatic, manifested by splenomegaly, abdominal pain, bowel disorders, anemia and thrombocytopenia, Kasabach-Merritt syndrome (anemia, thrombocytopenia and coagulopathy) and in rare cases by spontaneous rupture of the spleen [3].